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General NPI Number Information
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NPI Number | 1275687659
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Entity Type | Organization
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Legal Business Name | WELLSPACE HEALTH
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 8233 EAST STOCKTON BLVD. SUITE D
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City | SACRAMENTO
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State | CA
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Zip | 95817-3648
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Country | US
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Telephone | 916-550-5481
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Fax | 916-822-8974
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Provider Business Mailing Address
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Address Line | 1820 J STREET
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City | SACRAMENTO
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State | CA
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Zip | 95811-3010
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Country | US
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Telephone | 916-550-5481
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Fax | 916-822-8974
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. ALASDAIR JONATHAN PORTEUS
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Credential | PHD
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Telephone | 916-737-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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